CMS Price Transparency Data

Hepatitis C antibody test

Facility: Forks Community Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $50
Cash Discount Price: $80
vs. Medicare Baseline: 3.50x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Forks Community Hospital is $50. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $80. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 3.50x the Medicare baseline. Located in 530 Bogachiel Way, Forks, WA.

Cash / Self-Pay

$80

Average discount available for prompt cash payment at this facility.

Insurance Median

$50

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$14.27

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $14.27 (100%)

Cash / Self-Pay: $80 (561%)

Insurance Median: $50 (350%)

Cash: $80 (561% of Medicare)

Ins. Median: $50 (350% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $14.27 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 350% of the Medicare baseline (a markup of 250%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
UnitedHealthcare	$13 - $95	91%
Medicaid / KanCare	$31 - $41	217%
Coordinated Care (Mco) Mcd-All Plans	$33 - $42	231%
Community Health Network Mcr-All Other Plans	$40 - $50	280%
Humana	$40 - $50	280%
Tricare	$40 - $50	280%
Triwest-All Plans	$40 - $50	280%
Ambetter / Centene	$46 - $58	322%
Wellcare Med Adv - All Plans	$46 - $58	322%
Regence-All Other Plans	$51 - $64	357%
Community Health Exchange	$58 - $73	406%
Molina Commercial-All Other Plans	$82 - $103	575%
Aetna	$85 - $106	596%
Blue Cross Blue Shield	$85 - $106	596%
Cigna	$89 - $112	624%
First Choice-All Plans	$89 - $112	624%
Medicare (plans)	$318	2228%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $80.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 86803.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Forks Community Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 86803.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.